Original Article With Video Illustration| Volume 29, ISSUE 6, P1025-1033, June 2013

The Anterior Approach for a Non–Image-Guided Intra-articular Hip Injection


      The purpose of this study was to investigate and validate the accuracy and safety of a technique using an anterior approach for non–image-guided intra-articular injection of the hip by use of anatomic landmarks.


      We enrolled 55 patients. Injections were performed before supine hip arthroscopy after landmarking and before application of traction. After the needle insertion, success was confirmed with an air arthrogram and by direct visualization after arthroscope insertion. Accuracy and difficulty achieving correct needle placement were correlated with age, weight, height, body mass index, body type, gender, and surgical indication, as well as femoral and pelvic morphology. Forty-five patients who underwent injection in the office were followed up separately to document injection side effects. Needle placement accuracy was correlated to patients' demographics. All statistical tests with P values were 2 sided, with the level of significance set at P < .05.


      There were 51 correct needle placements and 4 misses, yielding a 93% success rate. The most common location for needle placement was the upper medial head-neck junction. Female gender was correlated with a more difficult needle placement and misses in relation to group size (P = .06). The reasons for misplacements of the needle were a high-riding trochanter, increased femoral version, thick adipose tissue over the landmarks, and variant of ilium morphology. Of 45 patients in the side effect study arm, 3 reported sensory changes of the lateral femoral cutaneous nerve that resolved within 24 hours.


      Hip injections by use of the direct anterior approach, from the intersection of the lines drawn from the anterior superior iliac spine and 1 cm distal to the tip of the greater trochanter, are safe and reproducible. Patient characteristics, such as increased subcutaneous adipose tissue or osseous anatomic variants, can lead to difficulty in placing the needle successfully. These characteristics can be predicted with the aid of physical examination and careful study of the pelvic radiographs.

      Level of Evidence

      Level IV, therapeutic case series.
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        • Daley E.L.
        • Bajaj S.
        • Bisson L.J.
        • Cole B.J.
        Improving injection accuracy of the elbow, knee and shoulder: Does injection site and imaging make a difference? A systematic review.
        Am J Sports Med. 2011; 39: 656-662
        • Heidari N.
        • Pichler W.
        • Grechenig S.
        • Grechenig W.
        • Weinberg A.M.
        Does the anteromedial or anterolateral approach alter the rate of joint puncture in injection of the ankle?: A cadaver study.
        J Bone Joint Surg Br. 2010; 92: 176-178
        • Dobson M.M.
        A check on the anatomical accuracy of intra-articular hip injections in relation to the therapy of coxarthritis.
        Ann Rheum Dis. 1948; 7: 172-174
        • Dobson M.M.
        A further anatomical check on the accuracy of intra-articular hip injections in relation to the therapy of coxarthritis.
        Ann Rheum Dis. 1950; 9: 237-240
        • Hollander J.L.
        Intra-articular hydrocortisone in the treatment of arthritis.
        Ann Intern Med. 1953; 39: 735-746
        • Hollander J.L.
        • Brown E.M.
        • Jessar R.A.
        Intra-articular hydrocortisone in the management of rheumatic diseases.
        Med Clin North Am. 1954; 38: 349-357
        • Lambert B.S.
        • Oliver J.M.
        • Katts G.R.
        • Green J.S.
        • Martin S.E.
        • Crouse S.F.
        DEXA or BMI: Clinical considerations for evaluating obesity in collegiate division 1-A American football athletes.
        Clin J Sports Med. 2012; 22: 436-438
        • Carofino B.
        • Chowaniec D.M.
        • McCarthy M.B.
        • et al.
        Corticosteroids and local anesthetics decrease positive effects of platelet-rich plasma: An in vitro study on human tendon cells.
        Arthroscopy. 2012; 28: 711-719
        • Diracoglu D.
        • Alptekin K.
        • Dikici F.
        • Balci H.I.
        • Ozcakar L.
        • Aksoy C.
        Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: Fluoroscopy versus arthrography.
        Arch Phys Med Rehabil. 2009; 90: 2112-2115
        • Kurup H.
        • Ward P.
        Do we need radiological guidance for hip joint injections?.
        Acta Orthop Belg. 2010; 76: 205-207
        • Leopold S.S.
        • Battista V.
        • Oliverio J.A.
        Safety and efficacy of intraarticular hip injection using anatomic landmarks.
        Clin Orthop Relat Res. 2001; : 192-197
        • Ziv Y.B.
        • Kardosh R.
        • Debi R.
        • Backstein D.
        • Safir O.
        • Kosashvili Y.
        An inexpensive and accurate method for hip injections without the use of imaging.
        J Clin Rheumatol. 2009; 15: 103-105
        • Mauffrey C.
        • Pobbathy P.
        Hip joint injection technique using anatomic landmarks: Are we accurate? A prospective study.
        Internet J Orthop Surg. 2006; 3: 1
        • Bum Park Y.
        • Ah Choi Y.
        • Kim Y.K.
        • Chul Lee S.
        • Hae Lee J.
        Accuracy of blind versus ultrasound-guided suprapatellar bursal injection.
        J Clin Ultrasound. 2012; 40: 20-25
        • McGarry J.G.
        • Daruwalla Z.J.
        The efficacy, accuracy and complications of corticosteroid injections of the knee joint.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1649-1654